Society's Knee-Jerk Inclination for Prescribed Drugs

We Americans don’t like to hurt. And we’re wealthy enough as a society not to have to. When we’re in pain, whether emotional or physical, we’re conditioned to “take something for it.”

And so we do. And every day in Florida, about five or six people take enough “something” that it kills them. In the past six years, just two drugs — oxycodone, the morphine-like chemical that makes painkillers like OxyContin and Percocet work, and methadone, another morphine equivalent — have killed more than 5,000 Floridians between them. Nearly 500 died after abusing prescription drugs in St. Petersburg and Tampa alone between 2005 and 2006, according to newspaper reports. In Miami-Dade and Broward counties, more than 500 people died in 2006 from prescription drug overdoses.

To get the drugs, some people “doctor shop” or “doctor hop” until they find a physician who’ll prescribe what they want. Others forge prescriptions — a healthcare professional I know just fired two workers, otherwise good employees, who were creating fake scripts for painkillers. Teenagers, meanwhile, often get the drugs from their parents’ medicine cabinets.

Illegal sales of prescription drugs are also big business. Organized drug rings, according to the federal Drug Enforcement Agency, travel to south Florida, get prescriptions and purchase drugs that they then resell back home. Florida, according to the DEA, has been a hotbed for internet holding companies that “organize (and sometimes control) websites, physicians, pharmacies and even pharmaceutical wholesalers.”

In an environment with plenty of both supply and demand, curbing the use of legal drugs is difficult. Prosecutions of physicians are high visibility but relatively rare — in DEA records of actions against physicians since 2001, I could find four Florida doctors or osteopaths who’d been sentenced to extended prison terms or life sentences for overprescribing drugs that killed people. More typical is the case of a Miami doctor who handed out nearly 40,000 doses of Schedule III and IV drugs — opiate painkillers, barbiturates and tranquilizers — in a two-month period and was sentenced to two months’ probation and eight months’ home detention. The DEA has moved successfully against internet pharmacies in Tampa, which it says became “ ‘ground zero’ for Internet diversion” of prescription drugs. Agents were able to close nearly 20 internet pharmacies there.

The Florida Legislature may again consider a bill, supported by law enforcement agencies, that would create a prescription drug-tracking database like those in at least 35 other states. House Bill 1011 would require pharmacists to report to the Department of Health — within 35 days — each time they fill a prescription for Schedule II, III or IV drugs. Those classes include anabolic steroids and anti-anxiety drugs like Xanax along with a range of painkillers and synthetic opiates like OxyContin and Vicodin. With the permission of the patient, doctors and pharmacists could then consult the database as part of getting “the information they need” to make good prescribing and dispensing decisions, says Bill Janes, the state adviser to Gov. Charlie Crist on drug policy.

In the bill’s current incarnation, law enforcement agencies could use the database to pursue an existing investigation, but not to start one. The database would start in Palm Beach and Broward counties and then be expanded statewide.

The bill’s sponsor Rep. Jack Seiler, a Democrat from Wilton Manors, says he’s a “vocal defender” of constitutional rights and is sensitive to the concerns over privacy that have derailed previous efforts to create a drug database. He believes the bill is drawn narrowly enough, requiring that only the highly restricted classes of drugs be logged. And he believes that the database will help target a problem he says is “getting worse every year.” Seiler says it’s unclear, given the state’s budgetary difficulties, whether there will be money to create and maintain the database, and the bill is for the moment on hold in committee.

Given the fact that the state is spending millions to create an internet-based information network where healthcare providers can store and share a patient’s entire medical record electronically [“Online Access,” June 2007, FloridaTrend.com], concerns about privacy seem a little moot. In addition, the state already monitors Medicaid recipients’ prescriptions, and the growth of electronic prescribing by physicians, which is likely to become universal within a decade, will create an instantaneously available record of who’s prescribing and dispensing certain drugs and who’s taking them.

Janes, the state’s drug czar, acknowledges the difficulty in fighting prescription drug abuse and the ability of users to switch to substitutes both legal and illegal. It’s important, however, he says, to give physicians, pharmacists and law enforcement officials another tool to help curb an epidemic. “You just have to keep pushing,’’ he says.

I don’t believe for a moment the notion that creating a tracking database will somehow lead physicians to undertreat hospice patients or others in chronic pain who have a legitimate need for relief — a position that’s been advanced by groups like the Association of American Physicians and Surgeons, an Arizona-based group, and organizations of “pain patients.” The dirty little truth about these drugs is that they feel very good, they’re affordable — and they’re easy to get. Just a few years ago I had my own encounter with oxycodone after a weekend-warrior type injury left me in a lot of pain, unable to sleep or lift my arm above my shoulder. At a walk-in clinic operated by a major local hospital, I was examined by a young physician who found no serious damage after a quick exam and an X-ray. Without any interrogation or investigation as to what other medications I might be taking, he gave me a prescription for a muscle relaxer and a form of oxycodone. At home, within a few minutes after taking the prescribed dose I retired to my sofa in a state of what could be called extreme comfort. I felt no pain in my shoulder, arm, back, side, hand — or anywhere else, for that matter. I stuck to the prescribed dose for a couple days and then stopped taking it. For someone as drug-averse as I am, the potential of becoming too accustomed to the drug was more worrisome than the prospect of finding some other way of dealing with the pain from the injury.

People who really need relief should be able to get it. Many others are in more pain, of one kind or another, for which pharmaceutical solutions aren’t the only answer. Until we can alter what’s become a knee-jerk inclination to “take something,” many more will be joining the ranks of those five or six each day who never make it back up off the sofa.